Active NPI
Dag Rivedal, RPH
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- Cudahy, WI
National Provider Identifier
1154694610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
- License
- 1176940
- Practice address
- 3201 E Layton Ave
Cudahy, WI 53110-1402 - Phone
- (414) 481-8220
- NPI assigned
- Feb 14, 2012
- Last updated
- Feb 14, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist | 1835P0018X | 1176940 | WI | Primary |
Addresses
Primary practice location
3201 E Layton Ave
Cudahy, WI 53110-1402
Mailing address
8509 W Cascade Oaks CT
Franklin, WI 53132-8530
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1176940 | WI | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Walgreen Co | Past | Accepting new patients | |
| Walgreen Co | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1329177600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1329177600000",
"number": "1154694610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8509 W CASCADE OAKS CT",
"city": "FRANKLIN",
"state": "WI",
"postal_code": "531328530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3201 E LAYTON AVE",
"city": "CUDAHY",
"state": "WI",
"postal_code": "531101402",
"telephone_number": "414-481-8220"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIVEDAL",
"first_name": "DAG",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-02-14",
"last_updated": "2012-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "1835P0018X",
"taxonomy_group": "",
"desc": "Pharmacist, Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"state": "WI",
"license": "1176940",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cudahy, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.